La. Admin. Code tit. 50 § I-3713
Current through Register Vol. 50, No. 12, December 20, 2024
Section I-3713 - Expedited Resolution of AppealsA. The MCO must establish and maintain an expedited review process for appeals when the MCO determines (either from a members request or indication from the provider making the request on the member's behalf or in support of the member's request) that taking the time for a standard resolution could seriously jeopardize the member's life or health or ability to attain, maintain, or regain maximum function. B. If the MCO denies a request for expedited resolution of an appeal, it must: 1. transfer the appeal to the timeframe for standard resolution; and2. make reasonable efforts to give the member prompt oral notice of the denial, and follow up within two calendar days with a written notice of the reason for the decision to extend the timeframe and inform the member of the right to file a grievance if he/she disagrees with the decision.La. Admin. Code tit. 50, § I-3713
Promulgated by the Department of Health and Hospitals, Bureau of Health Services Financing, LR 41:941 (May 2015), Amended by the Department of Health, Bureau of Health Services Financing LR 44287 (2/1/2018).AUTHORITY NOTE: Promulgated in accordance with R.S. 36:254 and Title XIX of the Social Security Act.